The Integrative Reviews Can Highlight Gaps in Knowledge to Guide Future Research

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Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach

• Micah D. J. Peters¹,
• Cindy Stern^one,
• Catalin Tufanaru¹,
• Alexa McArthur¹ &
• Edoardo Aromatarisⁱ

BMC Medical Enquiry Methodology book xviii, Commodity number:143 (2018) Cite this article

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Abstract

Background

Scoping reviews are a relatively new arroyo to evidence synthesis and currently there exists little guidance regarding the decision to cull between a systematic review or scoping review arroyo when synthesising testify. The purpose of this commodity is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) advisable.

Results

Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to ostend the relevance of inclusion criteria and potential questions.

Conclusions

Scoping reviews are a useful tool in the ever increasing arsenal of prove synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still crave rigorous and transparent methods in their carry to ensure that the results are trustworthy. Our promise is that with articulate guidance available regarding whether to conduct a scoping review or a systematic review, in that location will be less scoping reviews existence performed for inappropriate indications better served by a systematic review, and vice-versa.

Peer Review reports

Background

Systematic reviews in healthcare began to appear in publication in the 1970s and 1980s [one, 2]. With the emergence of groups such as Cochrane and the Joanna Briggs Institute (JBI) in the 1990s [3], reviews have exploded in popularity both in terms of the number conducted [one], and their uptake to inform policy and practice. Today, systematic reviews are conducted for a wide range of purposes beyond diverse fields of research, different prove types and for dissimilar questions [four]. More recently, the field of evidence synthesis has seen the emergence of scoping reviews, which are like to systematic reviews in that they follow a structured process, however they are performed for different reasons and accept some key methodological differences [v,vi,7,viii]. Scoping reviews are at present seen as a valid arroyo in those circumstances where systematic reviews are unable to run across the necessary objectives or requirements of noesis users. There now exists articulate guidance regarding the definition of scoping reviews, how to bear scoping reviews and the steps involved in the scoping review process [6, viii]. However, the guidance regarding the key indications or reasons why reviewers may cull to follow a scoping review arroyo is not every bit straightforward, with scoping reviews often conducted for purposes that exercise not align with the original indications as proposed by Arksey and O'Malley [5,6,7,8,9,10]. Equally editors and peer reviewers for various journals we have noticed that there is inconsistency and confusion regarding the indications for scoping reviews and a lack of clarity for authors regarding when a scoping review should be performed as opposed to a systematic review. The purpose of this article is to provide applied guidance for reviewers on when to perform a systematic review or a scoping review, supported with some key examples.

Indications for systematic reviews

Systematic reviews can be broadly defined equally a type of inquiry synthesis that are conducted by review groups with specialized skills, who ready out to identify and retrieve international show that is relevant to a particular question or questions and to appraise and synthesize the results of this search to inform practice, policy and in some cases, farther research [11,12,13]. Co-ordinate to the Cochrane handbook, a systematic review 'uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more than reliable findings from which conclusions can be drawn and decisions made.' [14] Systematic reviews follow a structured and pre-defined procedure that requires rigorous methods to ensure that the results are both reliable and meaningful to finish users. These reviews may be considered the pillar of evidence-based healthcare [xv] and are widely used to inform the evolution of trustworthy clinical guidelines [eleven, 16, 17].

A systematic review may be undertaken to confirm or abnegate whether or not electric current exercise is based on relevant bear witness, to establish the quality of that evidence, and to address any dubiousness or variation in practice that may be occurring. Such variations in practice may exist due to conflicting evidence and undertaking a systematic review should (hopefully) resolve such conflicts. Conducting a systematic review may too place gaps, deficiencies, and trends in the current evidence and can assistance underpin and inform future research in the expanse. Systematic reviews can be used to produce statements to guide clinical decision-making, the delivery of care, also as policy development [12]. Broadly, indications for systematic reviews are as follows [four]:

1. 1.

   Uncover the international prove

2. 2.

   Confirm current practice/ address any variation/ identify new practices

3. 3.

   Place and inform areas for future research

4. 4.

   Identify and investigate conflicting results

5. 5.

   Produce statements to guide controlling

Despite the utility of systematic reviews to address the above indications, there are cases where systematic reviews are unable to run across the necessary objectives or requirements of knowledge users or where a methodologically robust and structured preliminary searching and scoping activity may exist useful to inform the conduct of the systematic reviews. Every bit such, scoping reviews (which are also sometimes chosen scoping exercises/scoping studies) [8] have emerged every bit a valid arroyo with rather different indications to those for systematic reviews. It is important to note hither that other approaches to bear witness synthesis have likewise emerged, including realist reviews, mixed methods reviews, concept analyses and others [iv, 18,nineteen,twenty]. This commodity focuses specifically on the choice between a systematic review or scoping review approach.

Indications for scoping reviews

Truthful to their name, scoping reviews are an ideal tool to determine the scope or coverage of a body of literature on a given topic and give articulate indication of the book of literature and studies available likewise as an overview (wide or detailed) of its focus. Scoping reviews are useful for examining emerging evidence when information technology is nevertheless unclear what other, more specific questions can exist posed and valuably addressed by a more precise systematic review [21]. They can report on the types of evidence that address and inform practice in the field and the way the research has been conducted.

The full general purpose for conducting scoping reviews is to identify and map the available evidence [5, 22]. Arskey and O'Malley, authors of the seminal paper describing a framework for scoping reviews, provided four specific reasons why a scoping review may be conducted [5,6,7, 22]. Soon subsequently, Levac, Colquhoun and O'Brien further clarified and extended this original framework [7]. These authors acknowledged that at the fourth dimension, in that location was no universally recognized definition of scoping reviews nor a commonly acknowledged purpose or indication for conducting them. In 2015, a methodological working group of the JBI produced formal guidance for conducting scoping reviews [6]. However, we have not previously addressed and expanded upon the indications for scoping reviews. Below, we build upon previously described indications and suggest the following purposes for conducting a scoping review:

• To identify the types of available evidence in a given field

• To analyze key concepts/ definitions in the literature

• To examine how research is conducted on a certain topic or field

• To identify cardinal characteristics or factors related to a concept

• As a precursor to a systematic review

• To identify and analyse knowledge gaps

Deciding betwixt a systematic review and a scoping review approach

Authors deciding between the systematic review or scoping review approach should carefully consider the indications discussed to a higher place for each synthesis blazon and determine exactly what question they are asking and what purpose they are trying to achieve with their review. We propose that the most important consideration is whether or not the authors wish to use the results of their review to answer a clinically meaningful question or provide bear witness to inform practice. If the authors have a question addressing the feasibility, ceremoniousness, meaningfulness or effectiveness of a certain treatment or practice, then a systematic review is likely the most valid approach [11, 23]. Even so, authors do not always wish to ask such single or precise questions, and may be more interested in the identification of certain characteristics/concepts in papers or studies, and in the mapping, reporting or discussion of these characteristics/concepts. In these cases, a scoping review is the better option.

As scoping reviews do not aim to produce a critically appraised and synthesised result/answer to a particular question, and rather aim to provide an overview or map of the evidence. Due to this, an assessment of methodological limitations or risk of bias of the show included within a scoping review is generally non performed (unless there is a specific requirement due to the nature of the scoping review aim) [6]. Given this assessment of bias is non conducted, the implications for do (from a clinical or policy making point of view) that arise from a scoping review are quite different compared to those of a systematic review. In some cases, there may be no need or impetus to make implications for practice and if there is a need to do and then, these implications may be significantly limited in terms of providing concrete guidance from a clinical or policy making indicate of view. Conversely, when nosotros compare this to systematic reviews, the provision of implications for practice is a cardinal feature of systematic reviews and is recommended in reporting guidelines for systematic reviews [13].

Exemplars for different scoping review indications

In the following section, nosotros elaborate on each of the indications listed for scoping reviews and provide a number of examples for authors considering a scoping review approach.

To identify the types of available evidence in a given field

Scoping reviews that seek to identify the types of evidence in a given field share similarities with bear witness mapping activities as explained by Bragge and colleagues in a paper on conducting scoping research in wide topic areas [24]. Chambers and colleagues [25] conducted a scoping review in order to identify current knowledge translation resources (and any evaluations of them) that use, arrange and nowadays findings from systematic reviews to adapt the needs of policy makers. Following a comprehensive search across a range of databases, organizational websites and briefing abstract repositories based upon predetermined inclusion criteria, the authors identified 20 cognition translation resources which they classified into three dissimilar types (overviews, summaries and policy briefs) as well as seven published and unpublished evaluations. The authors concluded that evidence synthesists produce a range of resources to help policy makers to transfer and utilize the findings of systematic reviews and that focussed summaries are the most common. Similarly, a scoping review was conducted by Challen and colleagues [26] in order to make up one's mind the types of available testify identifying the source and quality of publications and grey literature for emergency planning. A comprehensive prepare of databases and websites were investigated and 1603 relevant sources of evidence were identified mainly addressing emergency planning and response with fewer sources concerned with hazard assay, mitigation and capability assessment. Based on the results of the review, the authors concluded that while at that place is a large torso of evidence in the field, issues with its generalizability and validity are as yet largely unknown and that the exact type and form of prove that would exist valuable to knowledge users in the field is not withal understood.

To analyze fundamental concepts/definitions in the literature

Scoping reviews are often performed to examine and clarify definitions that are used in the literature. A scoping review by Schaink and colleagues²⁷ was performed to investigate how the notion of "patient complexity" had been defined, classified, and understood in the existing literature. A systematic search of healthcare databases was conducted. Manufactures were assessed to make up one's mind whether they met the inclusion criteria and the findings of included articles were grouped into five health dimensions. An overview of how complication has been described was presented, including the varying definitions and interpretations of the term. The results of the scoping review enabled the authors to and so develop a complexity framework or model to aid in defining and agreement patient complexity [27].

Hines et al. [28] provide a further case where a scoping review has been conducted to define a concept, in this case the status bronchopulmonary dysplasia. The authors revealed significant variation in how the status was defined beyond the literature, prompting the authors to call for a 'comprehensive and evidence-based definition'. [28]

To examine how enquiry is conducted on a certain topic

Scoping reviews can be useful tools to investigate the design and conduct of research on a detail topic. A scoping review by Callary and colleagues²⁹ investigated the methodological design of studies assessing wear of a certain type of hip replacement (highly crosslinked polyethylene acetabular components) [29]. The aim of the scoping review was to survey the literature to determine how data pertinent to the measurement of hip replacement habiliment had been reported in primary studies and whether the methods were similar enough to let for comparison beyond studies. The scoping review revealed that the methods to assess wear (radiostereometric analysis) varied significantly with many different approaches being employed amongst the investigators. The results of the scoping review led to the authors recommending enhanced standardization in measurements and methods for futurity research in this field [29].

There are other examples of scoping reviews investigating research methodology, with perhaps the virtually pertinent examples being two recent scoping reviews of scoping review methods [9, 10]. Both of these scoping reviews investigated how scoping reviews had been reported and conducted, with both advocating for a need for clear guidance to better standardization of methods [nine, 10]. Similarly, a scoping review investigating methodology was conducted by Tricco and colleagues³⁰ on rapid review methods that have been evaluated, compared, used or described in the literature. A variety of rapid review approaches were identified with many instances of poor reporting identified. The authors called for prospective studies to compare results presented past rapid reviews versus systematic reviews.

To place primal characteristics or factors related to a concept

Scoping reviews can be conducted to identify and examine characteristics or factors related to a item concept. Harfield and colleagues (2015) conducted a scoping review to identify the characteristics of indigenous primary healthcare service delivery models [30,31,32]. A systematic search was conducted, followed past screening and study selection. Once relevant studies had been identified, a process of information extraction commenced to extract characteristics referred to in the included papers. Over 1000 findings were eventually grouped into viii key factors (accessible wellness services, community participation, culturally advisable and skilled workforce, culture, continuous quality improvement, flexible approaches to intendance, holistic health intendance, self-decision and empowerment). The results of this scoping review have been able to inform a best practice model for indigenous master healthcare services.

As a precursor to a systematic review

Scoping reviews conducted as precursors to systematic reviews may enable authors to place the nature of a broad field of evidence and so that ensuing reviews can be assured of locating adequate numbers of relevant studies for inclusion. They also enable the relevant outcomes and target group or population for example for a detail intervention to be identified. This tin can take particular practical benefits for review teams undertaking reviews on less familiar topics and can assist the team to avoid undertaking an "empty" review [33]. Scoping reviews of this kind may help reviewers to develop and ostend their a priori inclusion criteria and ensure that the questions to be posed by their subsequent systematic review are able to exist answered past available, relevant evidence. In this fashion, systematic reviews are able to exist underpinned past a preliminary and evidence-based scoping phase.

A scoping review commissioned by the United Kingdom Department for International Evolution was undertaken to decide the scope and nature of literature on people'southward experiences of microfinance. The results of this scoping review were used to inform the evolution of targeted systematic review questions that focussed upon areas of detail interest [34].

In their contempo scoping review on the acquit and reporting of scoping reviews, Tricco and colleagues¹⁰ reveal only 12% of scoping reviews contained recommendations for the development of ensuing systematic reviews, suggesting that the majority of scoping review authors exercise not conduct scoping reviews as a precursor to time to come systematic reviews.

To identify and analyze gaps in the knowledge base

Scoping reviews are rarely solely conducted to simply identify and analyze gaps present in a given cognition base, as exam and presentation of what hasn't been investigated or reported generally requires exhaustive exam of all of what is available. In any instance, because scoping reviews tend to exist a useful approach for reviewing show rapidly in emerging fields or topics, identification and assay of cognition gaps is a common and valuable indication for conducting a scoping review. A scoping review was recently conducted to review current research and place knowledge gaps on the topic of "occupational rest", or the residuum of work, balance, slumber, and play [35]. Post-obit a systematic search across a range of relevant databases, included studies were selected and in line with predetermined inclusion criteria, were described and mapped to provide both an overall picture of the current state of the prove in the field and to identify and highlight knowledge gaps in the area. The results of the scoping review immune the authors to illustrate several inquiry 'gaps', including the absence of studies conducted exterior of western societies, the lack of noesis around peoples' levels of occupational residuum, as well equally a dearth of testify regarding how occupational balance may exist enhanced. As with other scoping reviews focussed upon identifying and analyzing knowledge gaps, results such equally these allow for the identification of futurity research initiatives.

Word

Scoping reviews are now seen as a valid review approach for certain indications. A key difference betwixt scoping reviews and systematic reviews is that in terms of a review question, a scoping review will have a broader "scope" than traditional systematic reviews with correspondingly more expansive inclusion criteria. In improver, scoping reviews differ from systematic reviews in their overriding purpose. We have previously recommended the use of the PCC mnemonic (Population, Concept and Context) to guide question development [36]. The importance of clearly defining the key questions and objectives of a scoping review has been discussed previously by one of the authors, as a lack of clarity can result in difficulties encountered later on in the review process [36].

Considering their differences from systematic reviews, scoping reviews should all the same non be dislocated with traditional literature reviews. Traditional literature reviews have been used as a means to summarise various publications or enquiry on a item topic for many years. In these traditional reviews, authors examine inquiry reports in improver to conceptual or theoretical literature that focuses on the history, importance, and commonage thinking around a topic, issue or concept. These types of reviews can be considered subjective, due to their substantial reliance on the author'south pre-exiting cognition and experience and as they do not normally present an unbiased, exhaustive and systematic summary of a topic [12]. Regardless of some of these limitations, traditional literature reviews may however have some use in terms of providing an overview of a topic or result. Scoping reviews provide a useful culling to literature reviews when clarification around a concept or theory is required. If traditional literature reviews are contrasted with scoping reviews, the latter [vi]:

• Are informed by an a priori protocol

• Are systematic and oft include exhaustive searching for information

• Aim to be transparent and reproducible

• Include steps to reduce error and increase reliability (such as the inclusion of multiple reviewers)

• Ensure data is extracted and presented in a structured way

Another approach to evidence synthesis that has emerged recently is the production of evidence maps [37]. The purpose of these evidence maps is similar to scoping reviews to identify and analyse gaps in the knowledge base [37, 38]. In fact, most evidence mapping articles cite seminal scoping review guidance for their methods [38]. The 2 approaches therefore have many similarities, with perhaps the about prominent deviation being the production of a visual database or schematic (i.e. map) which assists the user in interpreting where evidence exists and where in that location are gaps [38]. As Miake-Lye states, at this stage 'it is difficult to determine where one method ends and the other begins.' [38] Both approaches may be valid when the indication is for determining the extent of evidence on a particular topic, particularly when highlighting gaps in the inquiry.

A further popular method to ascertain and scope concepts, especially in nursing, is through the conduct of a concept analysis [39,40,41,42]. Formal concept analysis is 'a process whereby concepts are logically and systematically investigated to form clear and rigorously constructed conceptual definitions,' [42] which is similar to scoping reviews where the indication is to analyze concepts in the literature. There is limited methodological guidance on how to behave a concept analysis and recently they have been critiqued for having no impact on practice [39]. In our opinion, scoping reviews (where the purpose is to systematically investigate a concept in the literature) offer a methodologically rigorous alternative to concept analysis with their results perhaps beingness more useful to inform do.

Comparison and contrasting the characteristics of traditional literature reviews, scoping reviews and systematic reviews may assist clarify the true essence of these unlike types of reviews (see Table 1).

Table one Defining characteristics of traditional literature reviews, scoping reviews and systematic reviews

Full size tabular array

Rapid reviews are some other emerging type of evidence synthesis and a substantial amount of literature take addressed these types of reviews [43,44,45,46,47]. There are various definitions for rapid reviews, and for simplification purposes, nosotros define these review types as 'systematic reviews with shortcuts.' In this newspaper, nosotros have not discussed the option between a rapid or systematic review arroyo as we are of the stance that perhaps the major consideration for conducting a rapid review (as compared to a systematic or scoping review) is not the purpose/question itself, just the feasibility of conducting a full review given financial/resource limitations and time pressures. As such, a rapid review could potentially exist conducted for whatever of the indications listed above for the scoping or systematic review, whilst shortening or skipping entirely some steps in the standard systematic or scoping review procedure.

In that location is some overlap across the vi listed purposes for conducting a scoping review described in this paper. For example, information technology is logical to presume that if a review group were aiming to place the types of available evidence in a field they would also be interested in identifying and analysing gaps in the noesis base. Other combinations of purposes for scoping reviews would besides make sense for certain questions/aims. However, we have chosen to listing them as discrete reasons in this newspaper in an effort to provide some much needed clarity on the appropriate purposes for conducting scoping reviews. As such, scoping review authors should not interpret our list of indications every bit a discrete list where merely 1 purpose can be identified.

Information technology is important to mention some potential abuses of scoping reviews. Reviewers may behave a scoping review as an culling to a systematic review in order to avoid the critical appraisal stage of the review and expedite the process, thinking that a scoping review may be easier than a systematic review to conduct. Other reviewers may conduct a scoping review in order to 'map' the literature when there is no obvious need for 'mapping' in this item bailiwick area. Others may behave a scoping review with very broad questions as an alternative to investing the time and attempt required to craft the necessary specific questions required for undertaking a systematic review. In these cases, scoping reviews are non appropriate and authors should refer to our guidance regarding whether they should be conducting a systematic review instead.

This article provides some clarification on when to acquit a scoping review every bit compared to a systematic review and clear guidance on the purposes for conducting a scoping review. We hope that this paper will provide a useful improver to this evolving methodology and encourage others to review, modify and build upon these indications as the arroyo matures. Further work in scoping review methods is required, with perhaps the most important advancement being the recent development of an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for scoping reviews [48] and the development of software and grooming programs to support these reviews [49, l]. As the methodology advances, guidance for scoping reviews (such every bit that included in the Joanna Briggs Institute Reviewer'south Manual) volition require revision, refining and updating.

Conclusion

Scoping reviews are a useful tool in the ever increasing arsenal of prove synthesis approaches. Researchers may preference the comport of a scoping review over a systematic review where the purpose of the review is to place noesis gaps, scope a body of literature, clarify concepts, investigate research behave, or to inform a systematic review. Although conducted for different purposes compared to systematic reviews, scoping reviews withal require rigorous and transparent methods in their bear to ensure that the results are trustworthy. Our promise is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there volition be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

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1. The Joanna Briggs Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5005, South Commonwealth of australia

   Zachary Munn, Micah D. J. Peters, Cindy Stern, Catalin Tufanaru, Alexa McArthur & Edoardo Aromataris

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ZM: Led the development of this newspaper and conceptualised the idea for a paper on indications for scoping reviews. Provided final approval for submission. MP: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CS: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CT: Contributed conceptually to the paper and wrote sections of the paper. Provided final blessing for submission. AM: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided concluding blessing for submission. EA: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided approving and encouragement for the work to go along. Provided final approval for submission.

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All the authors are members of the Joanna Briggs Institute, an show-based healthcare research constitute which provides formal guidance regarding evidence synthesis, transfer and implementation. Zachary Munn is a member of the editorial lath of this journal. The authors have no other competing interests to declare.

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Munn, Z., Peters, G.D.J., Stern, C. et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol eighteen, 143 (2018). https://doi.org/10.1186/s12874-018-0611-x

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• Received: 21 February 2018

• Accepted: 06 November 2018

• Published: xix November 2018

• DOI : https://doi.org/10.1186/s12874-018-0611-x

Keywords

• Systematic review
• Scoping review
• Evidence-based healthcare

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Source: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-018-0611-x

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